HC Deb 26 July 1967 vol 751 cc693-705

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Charles R. Morris.]

12.30 p.m.

Mr. Laurence Pavitt (Willesden, West)

In spite of the advances in the National Health Service, particularly since the present Minister took office, many of the problems within hospitals are bedeviled by an out-moded, archaic and Victorian attitude to human relationships held by a few people with power particularly over both doctors and nurses. Fortunately, these pockets are diminishing, but there are still areas which lead to untold harm which need to be rectified.

One of these is that of the provision of residence for doctors who need to be in the hospitals but are married with families. With regard to the resident married doctors, the attitude of some teaching hospitals seems more appropriate to the initiation rites of tribal Africa or some secret society. Enforced chastity cannot be necessary to make a married doctor into a better doctor.

I quote from the instructions issued by one of the London teaching hospitals to all resident medical staff: Wives, husbands and children will be welcomed in residents' quarters on Saturday and Sunday afternoons and at other times by arrangement with the R.M.O.… All visitors will leave residents' quarters by 11.30 p.m. and under no circumstances may any visitor stay the night. This is in respect of married people, qualified in their profession and prepared to take life and death decisions over their patients.

I have a case of a husband and wife who both happen to be doctors and both resident in the same teaching hospital. They had single rooms. In order to make sure that they did not meet too frequently, one was at the top north end of one corridor and the other at the bottom south end of another. In the same hospital maids were to be dismissed if they did not report when there was evidence that a wife had spent the night with her husband.

In respect of one London teaching hospital a wife has written this: My husband works an average of 19 hours per day, and if we are lucky he is able to come home for a night once a week. This means that in order to be with my husband occasionally I have to 'sneak' into the residence once or twice a week. The situation is made more ludicrous by the fact that this is prohibited as a few years ago the hospital governors declared that it was 'unhealthy' for wives to stay the night in residence. I have another case of a wife who writes: I shall not sign this letter as it may cause trouble for my husband and he would not have a cat's chance of ever getting another job let alone taking a consulant's post. I shall also post it in a different town from where he works. This is the wife of a professional man. It indicates a state of affairs that we should not permit in the National Health Service in 1967.

In 1962 I had a barrage of Questions to the then Minister, the right hon. Member for Wolverhampton, South-West (Mr. Powell). I quote answers to these with regard to Guy's Hospital, London. As a result of my Questions the building plan at that time was altered to provide 11 married quarters instead of 22 single quarters. I was delighted to receive that assurance from the then Minister. But I discovered from the Ministry in January this year that at Guy's Hospital only five flats for married doctors have been provided and of these only one is suitable for a married doctor who happens to have children.

I quote from Guy's Hospital Gazette of 31st November, 1962, that as a result of the Question that I put in this House a plea was made for: (1) The provision of flats for married housemen in all hospitals. In the present building programmes… (2) provision now of double bedrooms for all married housemen and facilities for a wife to have meals with her husband and stay the night… (3) All hospitals to make arrangements for flats to be available in the neighbourhood for housemen's families. Five years later we are still waiting for the implementation of this.

I had a Question about the London Teaching Hospitals where the matter is most acute. I have the pay slip of Dr. X, who is in a hospital not far away from this place. His take-home pay is £73 7s. 5d. He has £15 per month deducted for meals, leaving him £58. He is aged 25 and married with one child. The cheapest flat that he can find in Westminster—hon. Members will have some knowledge of this situation—is £40 a month, which would leave him £18 for food, heating, lighting, clothes and bringing up the baby. It is impossible. What has happened is that he is in London and his wife and baby are 200 miles away with parents. When I charged the Minister on 26th June with the fact that this problem was one of the major causes of emigration of doctors, he said that he had no evidence that emigration was increasing on this account.

I remind the Minister that the second question at his meeting with junior hospital doctors in Birmingham on 16th September made precisely this point, to the great approval of 500 doctors present. Since that Question I have had further evidence and will quote to him an article in the Sun dated 5th July: A young hospital doctor leaves Britain for Canada next week—not for a bigger salary, but so that he can enjoy married life. Dr. Neville Hodson-Walker, aged 24, is now living in Canada, and he said: About 50 per cent. of graduate doctors at Birmingham medical schools are either married or about to marry. They have to spend 12 months as housemen living apart from their wives. Letters to me have shown that this is a major cause of anti-N.H.S. mental attitude among doctors and that emigration is seen as the escape from intolerable pressures.

Another wife wrote: I suffered quite terribly in the two years after I first raised this question with you, with the consequence that I lost my third baby, after living and working in appalling conditions quite alone, when it should not have been necessary. It is very hard for us to feel now the loyalty to our country that is needed. Every doctor's wife I meet feels the same. People will not choose to work where it means separation of the family, of husband and wife. As a result of the efforts that I made in this House I have received nearly 100 letters from all over the country, from West Middlesex, Penzance, Bristol, Suffolk, Sunderland, Norfolk, South Shields, Lancaster, Aberystwyth and Aberdeen among many other towns.

I am not charging the Minister with any lack of intention. I regard him as—I know he is—sincere about it. I know that it is his policy to encourage hospital boards to provide resident accommodation for married staff. His Ministry has doubled the amount available in London. There were in the London teaching hospitals 33 units and 32 have been added. But this is still inadequate if we are to ease the basic problem among junior hospital staff who form the backbone of the hospital service.

I propose to the Minister that he should consider four courses of action which would help considerably in the situation. First, he should get an ad hoc working party from among the junior hospital doctors themselves to work on this problem of how to get residential accommodation satisfactory for the normal married life of a young man. The Latey Report, recently published, shows that many people are now getting married earlier. Therefore it is normal that a man should marry and have a family in the early twenties.

What we must do is to get the doctors themselves involved with the Ministry in constructive combined operations to find a solution to this problem. I feel sure that this will have far more benefit than the present rather sterile arguments. It is necessary that junior hospital doctors themselves shall be involved, because we must bypass the specialists and consultants, who are very much out of touch with the modern generation and very often themselves have an attitude of mind which does not help in the problem. One senior consultant told me that he would prefer that his housemen and registrars should not be married because that gives them more devotion to their work.

There is this attitude which we find so often in life of the boy at school who is beaten at an early age but who, when he gets an opportunity himself to do the beating, says, "I had to go through it, and so must you". Getting an ad hoc committee of junior hospital doctors involved in the problem would yield far more than other attempts which have been made to find solutions. Unless we get away from the B.M.A. establishment, with top consultants having prior consideration of all matters concerning hospital service, this could be a sterile debate. I ask the Minister to look at the possibility of getting the co-operation of junior hospital doctors.

The second thing which I would like him to do is to revise his Hospital Building Note No. 2A which gives instructions to hospital boards about the provision of residential accommodation for staff. Scale F, for example, is impossible to work out in terms of the costings given for the London area. Land costs and the whole question of building are totally out of proportion with those in the rest of the country. It would help considerably if there could be some revision, so that hospital boards and others concerned could be given an opportunity to go a little higher up the scale and provide the accommodation which married resident doctors need.

The third matter which I should like my right hon. Friend to consider is the possibility of a crash programme to provide mobile homes. I would refer him to some of the work which has gone on in this connection under the North-West Metropolitan Regional Hospital Board. In particular, there has been the recent decision to provide four units at the Barnet General Hospital at a cost of £7,900. I understand that a temporary home in a kind of super-caravan is no long-term solution to the problem, but this decision has allowed four families to be reunited, and four doctors will be able to live a normal happily married life. Although I understand that one would prefer permanent accommodation, the cost of about £2,000 a unit includes the provision of electricity, sanitation and all the other amenities needed to make it not just a super-tent, but a home in which a family can live together—small, but far more adequate than the case which I quoted of a doctor living 200 miles away from his wife and family.

It may be argued that whereas one is seeking a temporary solution very often the houseman is also a temporary appointment. He does six months in one specialty and six months in another in his pre-registration year. In spite of the fact that the families may change, inevitably the hospital will continue to have housemen and junior registrars, and a large number of those will be married and have families. Although the actual families may change, the problem remains, and even a temporary solution along the lines adopted by Barnet would be more helpful in seeking to solve the present problem.

My fourth suggestion is one which has emerged in our debates from time to time, and it is that my right hon. Friend should have immediate consultations with the Housing Corporation to find ways and means of providing cost rent housing or housing co-operatives whereby we could have co-operation, not only through hospital management committees, regional boards and boards of governors, but local authorities as well. The Parliamentary Secretary will know that, in the Housing Act of 1964, £100 million was set aside for this type of cost rent housing. If it could be pursued further, it might be another way whereby young doctors who are just starting on their careers could enjoy normal married life and who, in spite of the large number of hours that they work, still need to be ordinary members of the community as well as being devoted and dedicated doctors.

The problem of removal is more acute for this type of housing, because it means that greater control is necessary, and there is also provision for the protection of tenants in the 1965 Act which creates problems. Nevertheless, if the total number of available quarters can be increased and if there can be flexibility which can be organised at local level between short and long-term requirements, it will help solve the problem.

This is not just an acute human problem for the doctors for whom I am pleading today. I submit that it is basic to the kind of doctors we get and the kind of relationships which they can have with the families whom they serve, having had normal family lives themselves in the formative years when their children are young. We want to break down the barriers between doctors and the community, and I can think of no better way of starting on that process than by making sure that resident doctors can live normal married lives, and this will enrich the benefit they give to the nation at large.

12.45 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

My hon. Friend the Member for Willesden, West (Mr. Pavitt) has drawn attention to a matter of considerable and growing importance in the hospital service—the provision of an adequate amount and standard of married quarters for junior hospital doctors. I know that he has taken a particular interest in this matter for many years.

Over the years, due to the great increase—about 60 per cent.—in the number of junior hospital medical staff, the fact that the posts they hold at particular hospitals are of short duration, and the fact that like other people, young doctors are tending to marry at an earlier age, the provision of married quarters has been increasingly important. Thus, hospital authorities have been faced with a need for more residential accommodation, and a greater proportion of this as married accommodation.

My right hon. Friend regards the provision of a good standard of accommodation for resident medical staff, including married accommodation, as a matter of high priority. In a letter he sent to chairmen of hospital boards and hospital management committees in August last he especially emphasised the need to provide reasonable living conditions for junior medical staff.

At this point, let me deal with one of the four points which my hon. Friend mentioned, namely, the setting up of an ad hoc committee to represent the particular interests of junior hospital doctors in discussing the problem. As my hon. Friend knows, the Junior Hospital Doctors' Association is not a body which is recognised by the Minister, but there have been discussions about residential accommodation between the Health Departments and the profession in the context of the current negotiations on the conditions of service for hospital medical and dental staff.

These discussions are continuing. There are nine representatives of the professions in on these negotiations. Eight are doctors, and four of them are junior hospital doctors. There is no need, therefore, to set up ad hoc discussions with junior hospital doctors per se. My information is that there is no difference between the views put forward by the junior hospital doctors in those discussions and those which have been separately represented by my hon. Friend this morning.

Last December we began discussions with the profession on its memorandum on the current problems of hospital medical staff, and have now made good progress. One of the problems is the shortage of married accommodation. It is recognised that hospital authorities are endeavouring to overcome this shortage, but the memorandum suggests that greater efforts are required. I accept that this is so, but the extent of the effort already being made appears from the figures. In England and Wales today there are about 2,300 homes for married medical staff at hospitals. Of this number, nearly ready, one-third have been provided as new buildings in the last three years. Moreover, we have more than 1,200 additional units now being built or in design, and we aim to add to that a further 1,200 within the current building programme.

We should not forget that traditionally the residential accommodation provided was single accommodation. Another problem has been that for many of the older hospitals scope for improvement is not easy, due to the nature of the old buildings, site restrictions, and so on. More important, improvements in residential accommodation and the provision of married quarters involve capital expenditure. These improvements must compete for funds with clinical improvements such as operating theatres. Although we are specifically discussing married quarters for hospital doctors today, this is not a subject which can be treated in isolation. They are only one group amongst hospital staff generally requiring accommodation.

Various types of accommodation can be provided. Residential accommodation can be provided where staff must, because of the nature of their duties, live in or near the hospital premises or where the hospital concerned is remote from any housing development and staff cannot reasonably be expected to find their own accommodation. Staff who satisfy these conditions, and a high proportion of junior hospital medical staff can be expected to, may be housed in accommodation provided in a number of ways, by new building, the purchase or leasing of houses, conversion or adaptation of suitable buildings or the re-allocation of existing accommodation.

I have given the figures for new building done or planned. My hon. Friend will know that in 1964 the Ministry issued a Building Note on Residential Accommodation for Staff. This represented a considerable departure from tradition. In the past staff accommodation had too often been treated both in design and construction as though its function was that of a hospital department rather than that of providing good living conditions for ordinary men and women who happened to be members of the hospital service, sometimes with families, sometimes without. My hon. Friend read the list of rules regarding the meeting of husbands and wives at hospitals. I have no doubt that what he said, and my reply, will be read in the appropriate quarters. I am sure that my hon. Friend will not expect me to say more than that. The old tradition in accommodation tended to be unnecessarily expensive, and not well adapted to the needs of those who would have to live in such accommodation.

The new note did not lower standards. On the contrary, it tended to raise them. My hon. Friend says that he has evidence that the scale for the provision of such accommodation, and the monetary funding of it, is in many respects out of date and not commensurate with present-day costs. If my hon. Friend has such evidence, which is not in our possession, we would very much like to examine it. As I say, we have no such evidence, and we have had no such representations.

My hon. Friend talked about a crash programme to provide mobile homes which could be used in this emergency by young doctors and people who are confined to barracks, if I may use that expression. We take the view that this is not a tolerable thing. It is not ruled out, but we do not like it very much.

The new note recommended that staff should be housed in the same type of building as local housing authorities now provide, sometimes in houses or bungalows, but more especially in block of flats. These have two main advantages. First, they are particularly suitable for industrialised building methods which save both time and money. Secondly, it is easy to change whole blocks or individual flats from one use to another. For instance, a flat which has been used by a family can be adapted quickly and cheaply for single people living in bed-sitting rooms, or for that matter having their own living rooms as well as their own bedrooms.

Three blocks of this kind providing 55 units of married accommodation have recently been built at Greenwich as part of the new Greenwich District Hospital. They were recently opened by my right hon. Friend, and have aroused great interest. If my hon. Friend can find the time to see them, I shall make the necessary arrangements.

The other point which my hon. Friend made was about housing co-operatives, and I shall refer to this in a moment. In one way and another we are improving the situation by new building, but it takes time, and is not always the immediate answer to a pressing problem. Arrangements exist for hospital authorities to notify my Department of suitable properties which come on to the market, so that prompt action can be taken to secure them to remove the pressure. Approval is given in all but a few cases, where the property would have been unsuitable.

Some hospitals have been able to make land available to local housing authorities under arrangements which benefit both the housing authority and the hospital, since the authority will allocate to hospital staff some of the dwellings it provides for the general public.

Local housing authorities have been most helpful in accepting hospital employees as tenants where circumstances have allowed, and I would like to acknowledge their assistance in this matter. However many of them have long waiting lists and cannot authorise developments for this special purpose. Several regional hospital boards are making inquiries about using housing co-operatives, and it seems likely that an acceptable solution will be found within this sort of formula.

By all these means, which are alternatives, and additions to new building, we have spent about £1,300,000 on acquiring housing in the last three years. Of this, £800,000, or more than half, went to house married medical staff. Taking old and new buildings together, the total number of homes now available for married medical staff at hospitals amounts to about 2,300, of which about one-third have been provided in the last three years. We aim to double this by new building under the current programme, and of this increase half is under construction or in design. But my right hon. Friend is by no means satisfied that these actions are entirely adequate, and he is keeping the matter very much under review. He proposes to issue further comprehensive guidance in the near future to hospital authorities on the various ways of providing residential accommodation, particularly for junior medical staff.

I have referred briefly to caravans. We cannot rule them out, but we do not like them. I can see that in certain circumstances there is an argument for them to be used, and we are not adopting a dogmatic attitude.

I would like to touch on the question of Guy's Hospital, which my hon. Friend mentioned. Guy's are extremely sympathetic to the needs of doctors who require residential accommodation. Apart from the medical superintendent's house, there are at present five flats available for married medical staff, although three of them are tied to particular appointments whose holders may or may not be married. In addition, two other flats owned by the hospital's Endowment Fund are being converted into four smaller flats for married doctors, and these are likely to be ready by the end of the year.

For the future, Guy's have purchased some property in St. Thomas's Street with a view, subject to planning permission and obtaining vacant possession, to building a combined office/residential block so that the rents for the office accommodation will help to subsidise rents for the married quarters. Guy's hope that they will be in a position to start building in about five years.

The money for married quarters can only be made available at the expense of other desirable hospital development. Guy's, no less than other boards of governors, have the unenviable task of evaluating competing demands on their resources, and are supplementing these resources from their endowments to provide more accommodation for married doctors. But the main difficulty about making a substantial increase is that there is no site immediately available at Guy's where the accommodation can be built. If my hon. Friend has any ideas on this subject, we shall be glad to look into them. We are most anxious to use every possible source of information to deal with this problem.

I hope that I have been able to show my hon. Friend that both the Minister and the hospital authorities recognise the need for adequate provision of married accommodation, more especially for junior hospital staff, and that the hospitals are endeavouring to tackle the problem within the limits of their resources.

I think that my hon. Friend has raised a very important matter, and I hope that I have covered all the points which he put forward. We accept that there is some evidence, which my hon. Friend has provided today, of emigration resulting from this lack of provision, but I hope that I have been able to show that not only is the Minister sympathetic—sympathy is relatively easy to give away—but that we are doing something about this serious problem.

The debate having been concluded, Mr. DEPUTY SPEAKER suspended the Sitting until half-past Two o'clock, pursuant to Order.

Sitting resumed at 2.30 p.m.